1033427950 NPI number — MIDWEST PAIN CENTERS, INC.

Table of content: (NPI 1033427950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033427950 NPI number — MIDWEST PAIN CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST PAIN CENTERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033427950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21720 W LONG GROVE RD
Provider Second Line Business Mailing Address:
STE. C200
Provider Business Mailing Address City Name:
DEER PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60010-3732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 BIESTERFIELD RD
Provider Second Line Business Practice Location Address:
STE. 302
Provider Business Practice Location Address City Name:
ELK GROVE VILLAGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60007-3361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-701-5040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JOSHI
Authorized Official First Name:
JAY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
847-701-5040

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  036115091 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: K28134 . This is a "MEDICARE ID-LOCALITY 15 PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 131846500 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1619628 . This is a "BCBS PROVIDER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: K28133 . This is a "MEDICARE ID-LOCALITY 16 PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00349345 . This is a "MEDICARE ID-RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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